As grim stories emerge from Wisconsin nursing homes, one took steps to halt coronavirus and keep everyone safe

It had been two days since Mary Spooner had been able to reach her husband of 52 years. Ernest, 73, usually called several times a day from his bed at Allis Care Center.

Finally, Mary got through on the main line at the nursing home April 28. She insisted the staff put the phone up to his ear. He was mumbling, which was not normal. She hung up worried. No one at Allis Care Center mentioned coronavirus, she said.

About an hour later, Mary said the staff called back. Ernest was being transported to St. Francis Hospital. This time, the staff told her Ernest had tested positive for coronavirus — which meant he had been tested prior to her earlier call. He died at the hospital a week later, May 5, medical examiner reports confirm.

An employee at the center, who asked not to be named for fear of losing her job, told the Journal Sentinel she had seen Ernest’s phone disconnected in his final days there.

Facility spokeswoman Lauren Ashley German said she wasn’t aware of any unresolved phone problems. She contended the staff had notified Mary of the test result April 27, the day before his hospitalization.

Mary isn’t the only person who told the Journal Sentinel about troubles reaching residents or staff at Allis Care Center, where at least 10 residents have died from COVID-19.

Further, in the weeks since nursing homes and other long-term care centers have closed to visitors, many family members have reported difficulty reaching loved ones at multiple locations. While owners and spokespeople insist their staffs are following health guidelines, employees in several facilities have reported shortages of protective equipment, unanswered calls for help and mounting cases of COVID-19.

But in Washington County, Autumn Oaks Assisted Living has demonstrated a rare trajectory. Once facing four active cases of coronavirus, the staff took aggressive measures to test, separate and protect residents and themselves. It appears they’ve stopped the spread, at least for now.

Health officials there said actions taken at Autumn Oaks could be replicated elsewhere with the right public oversight and support.

Meanwhile, the death toll climbs. At least 40% of all Wisconsin residents who've died with COVID-19 were living in long-term care facilities, according to May 8 data from the state Department of Health Services.

That includes at least 67 residents of nursing homes and 45 residents of assisted living facilities, according to DHS data provided Thursday in response to a request from the Journal Sentinel.

Mitchell Hagopian, managing attorney for Disability Rights Wisconsin, said he worries especially about other settings that are not getting the same attention as nursing homes, like assisted living facilities and smaller group homes.

At Country Villa Assisted Living in Pulaski, a state inspection May 5 found that 25 out of 35 residents tested positive for coronavirus while the facility failed to staff enough caregivers to meet their needs. At least one resident, Pulaski's former fire chief, died from the virus.

While the owner told inspectors that staffing was adequate, employees said many people were not showing up for work and there was not enough protective equipment. Several staff members quit, and 11 tested positive. A nurse told inspectors there weren't separate staff members designated for positive and negative patients, and staffers were not changing gowns between visiting different rooms.

State officials ordered the facility not to accept any new residents and to create a plan for improvement.

Stopping the virus

Debra Suski saw coronavirus coming from thousands of miles away. Before it hit the U.S., she was thinking about what it could mean for Autumn Oaks, the assisted living facility in Slinger where she servesas head nurse.

In mid-March, a week before statewide orders, Autumn Oaks started restricting visitors. Suski said there were enough masks for staff to change them daily and for residents to have them, too.

When a resident died April 17 from another medical issue, staff members asked the coroner to run a test for coronavirus, just in case. It was positive.

At the same time, another resident got sick. Suski believes the virus may have come from a visitor just before the lockdown or an asymptomatic staff member.

Regardless, it was there. Suski knew the resident had recently been visited by two other residents.

Though the residents didn’t have telltale symptoms, Suski had them both quarantined to their rooms, assigned specific staff members to them to reduce spread and immediately had them tested. Staff caring for those residents used the more protective N95 masks.

The tests came back positive. Suski also tested everyone else in the same unit, sticking swabs deep up their noses.

Suski found a fifth case. Since then, she said there haven't been any more positive cases and everyone who had the virus has gotten better. She said no staff have been sick.

Theresa Remsik Traczek, a public health nurse for the Washington Ozaukee Health Department, helped Autumn Oaks manage the outbreak. She said she was impressed by the measures Suski and staff had already taken on their own, such as setting up portable toilets for the residents who tested positive so they wouldn’t share space with other residents.

Traczek also commended Autumn Oaks' leadership for communicating with its staff, residents and their families about the positive cases and protective steps being taken.

“I think it builds trust with the employees that they’re coming to a safe place,” Traczek said. “It’s that peace of mind that in turn protects the residents.”

'He never came home'

In Milwaukee, Mary Spooner spent her Friday making funeral arrangements for Ernest.

The two had met decades ago at a restaurant in Chicago, where Mary was working and Ernest waited for her to finish so he could take her out for dinner.

“We just clicked,” Mary said. “From then on we were sort of a couple.”

The two moved to Milwaukee, where Mary birthed six children and the couple adopted three more. Ernest worked for 25 years at the American Linen Supply Co. plant on North Avenue.

Ernest was only supposed to be at Allis Care Center temporarily for rehabilitation.

"I took him there for rehab and he never came out," Mary said. "He never came home."

Initially, Ernest tested negative for the virus, Mary said. He was sharing a room with another resident, separated by just a curtain.

A spokesperson for Allis Care Center said both residents tested positive on the same day. However, an employee at the center told the Journal Sentinel that the other resident in the room tested positive first and they continued to share a room.

The employee, who did not want to be named out of fear of losing her job, said she had noticed the phones in Ernest's room were not working. She said she has picked up other phones at the facility and found no dial tone.

The employee said she's been frustrated by how often residents' calls for help go unanswered by other staff. When residents hit their call lights, she said they often stay on for hours.

"I hear residents scream for help," the employee said. "It looks like Christmas most of the time because that’s how many lights be on."

A friend of a resident at Allis Care Center, who asked not to be named, fearing retribution against her friend, said her friend has had trouble getting help.

"When she is able to put her light on, it stays on for hours until she forgets what she was going to ask for," the friend said.

The friend has been visiting the facility weekly for a decade, and they generally talk to each other on the phone every night. But sometimes she can't get through. She said on past visits, she has occasionally found her friend's personal phone unplugged.

“Sometimes I call the facility when I can’t reach her," she said. "It’ll just ring 45 times and click off."

A spokeswoman for the facility said she was "not aware of any unresolved Allis Care Center phone line issues" in patients' rooms and that facility policy is to respond to all callsfrom family members and others within 24 hours.

Few answers

Multiple people with family members in long-term care facilities told the Journal Sentinel about difficulties getting information about their loved ones.

David Thompson said his mother, an 87-year-old retired nurse, used to "light up like a Christmas tree" when he would visit her at Symphony, a nursing home in Glendale. He would cut her hair, help her clean up.

Thompson still visits her frequently, talking through her window. She's visibly more distressed and in need of washing, he said.

"Emotionally it’s draining," he said. "When I’m at the window watching my mom cry, that’s just heartbreaking. It crushes me right there in the parking lot."

Now he has to count on staff to look out for her — staff who he has trouble reaching.

"They don’t even answer the phone when you call," he said.

A spokeswoman for Symphony said administrators are working to "increase communications" and have shifted staff to make more people available to take phone calls.

Getting answers can also be a problem for staff in long-term care facilities.

An employee at Franciscan Villa found out from news reports about the death of a resident at Franciscan Courts, a building on the same complex.

Richard Malmberg was hospitalized March 24 and tested positive for the virus March 25, according to a report from the Milwaukee County Medical Examiner's Office.

On March 30, the employee received a text alert from work, which she shared with the Journal Sentinel: "We currently have 0 positive cases on our campus. Great job with all your precautions!"

Malmberg died April 1. The next day, there was another text: "Team great work this week we still have 0 positive corona residents on our campus! Keep up good work."

Another resident of Franciscan Villa was hospitalized April 5 and died April 11, according to the medical examiner.

The last week in April, the employee said administrators notified staff of one positive case at the Villa.

“We were told nothing except there is one case at the Villa. Nothing about staff getting it or about any deaths,” the employee said.

Under new federal guidelines, administrators are now supposed to inform staff and residents of new cases.

The employee said the lack of communication in the first weeks of the virus made it hard for staff to stay safe while there was also a shortage of protective equipment. She said when she was sick last month, she was told she needed to wear a mask for two weeks but the administration did not provide any masks.

When staff did get masks about three weeks ago, they only got four each, she said, so many staff have relied on homemade masks. She said each staff memberreceived four more masks on May 4.

A spokeswoman for the facility said she could not comment on the employee's account about protective equipment and the number of cases at the facilities.

Changes sweeping nation

After weeks of refusing to share information about the spread of coronavirus in nursing homes, citing patient privacy, administrators will soon have to publicly share information about cases and deaths, under new rules from the Centers for Medicare and Medicaid Services.

In Wisconsin, Gov. Tony Evers announced May 4 a goal of testing all nursing home residents and staff members statewide.

Asked how this would be accomplished, state Department of Health Services officials did not share details with the Journal Sentinel. In an email sent May 6, a DHS official notified leaders of local health departments that they would soon be asked about their capacity to assist with testing.

Kirsten Johnson, director of the Washington Ozaukee Health Department, said she hadn’t been consulted about testing before Evers’ announcement. She said staff already have full schedules trying to track the spread of the virus and test those with symptoms, some of whom are still being turned away from other clinics.

"We are still getting calls daily from people who are being turned away from testing who are symptomatic," she said. "Spreading our resources more thin by asking us to test all nursing homes is a challenge that we aren’t able to resolve."

Johnson said she would like to see more assistance from the state for testing, supplies, medical care and guidance in nursing homes.

She said her department has guided as many facilities as possible on setting up isolation units, protective equipment and other protocols. But she suspects not all nursing home staff have what they need for the unprecedented challenge of responding to a pandemic.

In Maryland, another state plagued by outbreaks in nursing homes, Gov. Larry Hogan recently announced new strike teams to provide testing, protective equipment, medical care and other assistance in nursing homes there.

In Massachusetts, health officials launched a hotline for families with loved ones in nursing homes.

Dr. Alice Bonner, a senior adviser for the Institute for Healthcare Improvement, said it's important for people to be able to get information about the health of their loved ones and conditions inside their homes.

"You deserve to get information you’re looking for; you deserve to get a call back," she said. "And sometimes you do have to get the health department involved if you don’t get any other recourse."

Resources

Long-Term Care Ombudsman: Contact Wisconsin's ombudsman at (800) 815-0015 or boaltc@ltc.state.wi.us for help with concerns about quality of care at nursing homes, assisted living facilities or other long-term care facilities.

State complaint survey: File a complaint about a facility with the state Department of Health Services by filling out the online form or calling (800) 642-6552.

Journal Sentinel survey: Tell us about your experiences with long-term care facilities by filling out our online survey at bit.ly/WIfacilitysurvey.

Rory Linnane reports on public health and works to make information accessible so readers can improve their lives and hold officials accountable. Contact Rory at (414) 801-1525 or rory.linnane@jrn.com. Follow her on Twitter at @RoryLinnane.